Hi Henci,
I own a debate forum on Yahoo, and one of our more active members is a malpractice attorney who specializes in uterine rupture cases and cytotec cases. We've butted heads on various lists across the web, and while sometimes I want to choke him, deep down I believe his intentions are good...however misguided.
Anyway, he shared the ACOG's article on the dangers of VBAC in birth centers today. I'd already seen it, and the biggest problem I had with it is that it omits any comparison to VBAC outcomes and/or rate of complications in hospitals. So, VBAC is dangerous in birth centers...compared to what??? I was hoping you might have the full text of this study, and could share it or atleast share your thoughts on it. You've helped me in the past with figuring out inconsistencies in other articles. If you can spare the time, it would be most appreciated.
Here is the article that was posted...I can't find the actual abstract.
Researchers Advise Against Attempting VBACs in Birth Centers
Washington, DC -- Women and birth centers are strongly advised against attempting VBACs (vaginal birth after cesarean) in birth centers because the health risks are too great, according to the results of a new national study published in the November issue of Obstetrics & Gynecology. While researchers found that women attempting VBAC in a birth center who were at least 42 weeks of gestation or who have had more than one previous cesarean delivery had the worst outcomes, they advise all women against attempting a VBAC anywhere but in a hospital.
During the 1980s, the number of birth centers across the US increased. These nonhospital facilities were designed to provide maternity care to women at low risk of obstetrical complications. At the same time that these birth centers were increasing, studies suggested that VBACs were safe for some women. The national VBAC rate rose from 3% in 1980 to 20% in 1990 as more women attempted to avoid subsequent cesareans.
Researchers from several US institutions, supported by the National Association of Childbearing Centers Foundation, prospectively studied the birth outcome data from 1,453 pregnant women who had at least one previous cesarean and who attempted to deliver via VBAC at one of 41 US birth centers. The study covered a 10-year period, from 1990 to 2000. Ninety-three percent of these women had only had one previous cesarean delivery and 46% had also had a previous vaginal birth.
While 87% of all women who labored in a birth center delivered vaginally, only 76% of all the women actually delivered in the birth center-the rest delivered at a hospital after being transferred due to complications. Women with more than one cesarean delivery were significantly more likely to have a uterine rupture when attempting VBAC in a birth center. Gestational age of at least 42 weeks also raised the risk for a negative outcome.
While there were no maternal deaths, overall there were five stillbirths and two newborn deaths among women attempting VBAC. There also were six uterine ruptures among women attempting VBAC.
Data showed that 24% of all women who attempted VBAC at a birth center were transferred to a hospital before they gave birth due to medical problems such as failure of labor to progress, fetal conditions, and maternal complications. Of the 24%, 23 women were transferred immediately to hospitals and 324 were transferred at some point during a trial of labor.
Forty-two women (3.8%) who successfully delivered their baby via VBAC in a birth center were transferred to a hospital after delivery, approximately half due to maternal problems and half for newborn problems. The most common reason for maternal transfer was for repair of lacerations. Respiratory problems were the most common reasons for neonatal transfers.
According to the researchers, women with a previous cesarean delivery are at an increased risk for complications during subsequent births compared with women who have not had a cesarean. Women attempting a VBAC, therefore, cannot be considered low risk and are best cared for in a hospital setting to deal with potential complications. The researchers encourage more hospitals to offer VBACs so that women who wish to avoid another cesarean have a safe place to deliver. They also emphasize that their study underscores the importance of implementing policies and strategies to avoid unnecessary primary cesareans in the first place.
Contact: Bruce Flamm, MD, University of California, Irvine, at bruceflamm@aol.com or 951-353-4412.
Thanks in advance,
Mandy Bosch
Northern VA By: SelkieDoula |